HomeMy WebLinkAbout78 Mission Blvd 06-82 WallRECEIVED
Ct'i'Y OF SANFORD PERMIT APPLICATION S E P
� G
Permit # : C 0 ri ti Date:
Job Address: Q, Al7 61c.J 8C_✓i� ��i�vrr�2+� of 37-771
Description of Work: e&,vrI-V5 &Cckc (V4 ce_. 'I o C--D6c5 OF (40 -R-TVI
Historic District: Zoning:Value of Work: $ Gvl 55�
Permit Type: Building X Electrical Mechanical Plumbing Fire Sprinkler/Alartn Pool
Electrical: New Service -# of AMPS Addition/Alteration _ Change of Service 'Temporary Pole
Mechanical: Residential Non -Residential Replacement New (Duct Layout & Energy Cale. Required)
Plumbing/ New Commercial: # of Fixtures # of Water & Sewer Lines # oC Gas Lines
Plumbing/New Residential: # of Water Closets Plumbing Repair - Residential or Commercial
Occupancy Type: Residential Commercial _ ^ Industrial Total Square Footage:
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel 9:
6210
ew�&A . C)e,OU
(Attach Prouf of Ownership & Legal Description)
Owners Name & Address: /UG'Zll T i Bc`� /Yl IS�,1 f7rJ
lvoo l= 1 sf a% >rilyPhone: Wog 323- 3"13y
Contractor Name & Address: fl0rv',E7'S> C6,N`.?1tg c-ngN L-L-C_ I-yo 6OL.I✓l/1 GT-
��}lVl FL. 1, Z % 7 1 State License Number: Use. 17—e � 7 30
Pltatrc r`k Fax: r{ 3? - 3 3 V - �U ci Contact Person: 1 Lyi2i� :565 Phone: rf o 7 - z Zl - 4f 90-9
Bonding Company:
Address:
Mortgage tender: .
Address:
Arehitect/Engineer:
Address:
Phone:
Fax:
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the
issuance of a permit and that all work will be performed to meet standards of all laws regulating construction in this jurisdiction. I understand that a separate
permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, 11EATERS,'T'ANKS, and
AIR CONDITIONERS, etc.
OWNER'S AFFIDAVIT: I certify that all of the roregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY, IF YOU INTENDTO OBTAIN FINANCING, CONSULT WI'T'll YOUR LENDER OR AN
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may W found in tine public records of
this county, and there may be additional permits required from other governmental entities such as water management districts, state agencies, or federal agencies.
Acceptance of ppermit is verification that I will notify the owner of the property of the requir( mats of Flond Lie Law ('S 713.
Z:;
Signature of Owner/Agent Dale
Signature of Contractor/Agent Date
PrMMary-St+-If+l-i
Print Conti ctor e Name
9' f> CAL
Lor'n1
/
attire o otary-Stat o i' rlda Date
KENNETH PAUL FROST
MY COMMISSION # DD 046754
Owner/Agent is,� rso ^ ovgA8I5ff%iG9ptember 22, 2005
Contractor/Agent is Personally Known to Me or
_ Produced ID i 80(Y3 N0'f W FL Not Service & WrK ing, I(c,
Produced I D
APPLICATION APPROVED BY: Bldg: e�L mg:
t> dines: FD:
(Initial & Date) , nitial &
Date) (Initial & Date) (Initial & Date)
Special Conditions:
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